A survey of current myocardial protection practices during coronary artery bypass grafting

Ann R Coll Surg Engl. 2004 Nov;86(6):413-5. doi: 10.1308/147870804669.


Objective: To identify current myocardial protection strategies for coronary artery bypass grafting (CABG) across the UK and Ireland.

Methods: A questionnaire survey of 15 questions was sent to practising cardiac surgeons between June and October 2002. The list of surgeons was obtained from the Society of Cardiothoracic Surgeons of Great Britain and Ireland database and they were contacted by postal and electronic mail.

Results: 118 (73.7%) out of 160 surgeons responded to the survey. 61 (51.7%) perform CABG on-pump (ONCAB) while 10 (8.5%) practice off-pump CABG (OPCAB). 47 (39.8%) perform either depending on individual cases. Of the 108 surgeons performing ONCAB, 91 (84.3%) use cardioplegia while 17 (15.7%) use cross-clamp and fibrillation techniques. Of those using cardioplegia, 76 (83.5%) use blood cardioplegia, 15 (19.7%) use warm-blood and 60 (78.9%) use cold-blood cardioplegia. 15(16.5%) use crystalloid cardioplegia. Retrograde cardioplegia is used by 23 (25.2%). We find an interesting variation of practice in relation to specifics like warm induction, graft cardioplegia, hot-shot, single cross-clamp, hypothermia and venting procedures. An overwhelming majority of surgeons performing OPCAB use the Octopus stabiliser (n=44, 77.2%) with some others preferring the Genzyme system. Supplementary stabilisation is not commonly used. While most OPCAB surgeons use intracoronary shunts (n=51), some prefer blockers (n=9) and others use coronary sloops (n=36). Ischaemic preconditioning is not commonly practised. Several surgeons have changed their practice of myocardial protection in the last 5 years (n=45).

Conclusions: This survey gives us an interesting insight into current myocardial protection practices in the UK and Ireland and may be useful for future reference.

MeSH terms

  • Blood
  • Coronary Artery Bypass / methods*
  • Health Care Surveys
  • Heart Arrest, Induced / methods*
  • Humans
  • Hyperthermia, Induced / methods
  • Hypothermia, Induced / methods
  • Ireland
  • Professional Practice*
  • Surveys and Questionnaires
  • United Kingdom